Provider Demographics
NPI:1821375502
Name:SURGERY CENTER OF MANHATTAN BEACH LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF MANHATTAN BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:RISPLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-648-2229
Mailing Address - Street 1:3500 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 134
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3638
Mailing Address - Country:US
Mailing Address - Phone:310-648-2229
Mailing Address - Fax:310-333-0666
Practice Address - Street 1:3500 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 134
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3638
Practice Address - Country:US
Practice Address - Phone:310-648-2229
Practice Address - Fax:310-333-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL-24936261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical